I am a MT in La and would like to get some information on medical massage billing, if anyone has some thoughts or answers.

I work w/ a PT/Chiro practice, so the billing to Insurance for my massage therapy is under PT not chiro. It seems Insurance takes a more favorable view to PT (& pays more).
Billing is handled by front office, so I can't help you there.

Gene, I'm a massage therapist in a chiro' s office and do all my own billing. I use a program called massage office. It's old but cheap and does the trick. In Washington where I work, Insurance companies want these done electronically. I would contact the providers that your billing and ask them if they have a website that they provide for providers. Many companies now want us to use their sites. Hope this helps.. any specific questions let me know.
best regards
Mike

Insurance billing is somewhat of a game Gene. I use to work the front desk part time for the Clinic I do massage at. At times I would have to verify Pt's insurance. We check on consideration for specific codes you primarily use at the clinic.

With a particular insurance company, I asked them if they cover massage therapy. The answer was a quick no. Hmmmmm. I asked to run some billing codes by them. Mixed in was 97124 which they said they consider. Hmmmm. I then explained to the agent that was the billing code for massage. I could sense the agent scratching their head on the other end of the phone. :) Figure that one out.

Insurance billing requires tenacity. (My wife does it for a living) In the clinic I work at everything is billed through the D.C.s NPI # Barbara is right, more insurance companies will accept codes for PT like 97140 (Manual Manipulation). Be careful with your notes though. Insurance companies look for specific activities using PT codes like Myo Release techniques, assisted stretching, etc.

What do you and your chiropracticors reccomend : massage before or after the skeletal adjustment?

The chiropractors that I work with, like it if the client comes into have a massage first and then have the adjustment, because the muscles are warmed and relaxed it helps the adjustment go easier

I think it should be up to the client to try it both ways. I have some who like to have the adjustment first then massage, and it really seems to work better for them. Although, I must say that most people prefer having the massage first then getting adjusted. If possible, I think they should try both ways to see which one works best for their body.

My chiro goes by individual client. If somebody is real tight and has a hard time letting go before an adjustment then massage first. If they are fairly loose then massage after. He showed me an article suggesting that a massage done after has shown to hold an adjustment longer.

I generally would give a massage first but each client is different so if they do not know what works best for them then try both and determine what is best for them.

The Chiro I work with prefers massage prior to adjustment. Most of the massages are billed through the clients insurance and the front desk deals with all of that. There is one insurance company that they deal with that will not pay if the massage and adjustment are on the same day... go figure!

I am glad to see this group get off to such a great start! I was surprised to see so many posts after starting the group. To introduce myself, I am a massage therapist in Iowa. I have worked in a chiropractic clinic for nine years now. The chiropractic clinic is my father’s, who has had his practice for 40 years. I honestly love working in this setting and think it is an ideal environment for many massage professionals. The benefits of the combination of chiropractic and massage are great for clients and patients. Generally, my dad prefers his patients get a massage first, however many prefer the relaxing after an adjustment. I have clients who see other chiropractors and I have found the “before or after” preference has a lot to do with the method or technique the chiropractor uses. My father uses the Palmer or Gonstead technique and I think they generally prefer a massage prior to the adjustment. I have had other chiropractors also say a post-adjustment massage does help "hold" the adjustment better. It is a personal preference for many.
As far as insurance reimbursement, I have been hesitant to start. I felt my business was succeeding without it and I honestly have not had many clients request reimbursement.

I agree with you Ivy, a Chiropractic setting is an ideal location for a professional MT. Massage and Chiropractic together do so much more for a patient than either modality can achieve by itself. Together they are quite synergistic.

I've been working with my D.C. for 2.5 years now and have found it very rewarding. Thank you for starting this group.

Peace

I just recently started working for a chiropractor two months ago. It is becoming a very rewarding experience. Since I have started many of our patients agree that their adjustments and benifits are lasting longer. It has been wonderful to see the clients realize how much easier their adjustment go when they recieve massage before hand.

Thanks for starting this group, Ivy! I'm in MI and have been with two great Palmer-trained chiropractors for over four years now. I love the diversity of client needs in this environment, which have enabled my skills as a therapist to grow. With reference to the 'before or after' discussion, I find people generally get an easier adjustment after I loosen them up; but I see several who need deeper work on the soft tissues (particularly adjacent to a joint) that I find is better facilitated by their having an adjustment first. I have been delighted to see just how much long-term relief somebody can have once the very deep structures can be addressed, although isolating them sometimes presents a challenge ;o}

Hello everyone I am new to this group and to the massage therapy industry. I am a student and I plan to get my license early next year. I also have plans to work in a chiropractor clinic and I value anyone's experience that wishes to share. I look forward to talking with everyone. Dayna

Greetings all:

I do not work for a chiropractor; I work in the massage room at Fairbanks Memorial Hospital. There we give staff and their families massages at a discounted rate. I also do comfort massages in the wing of the hospital where seniors and those unable to care for themselves live. Therefore, if my questions sound inane regarding Massage in Chiropractic, you'll understand why....

So...here goes. From an outsider looking in, it would seem to me that a short massage (say, 30 minutes) prior to an adjustment--would warm up the muscles around the area of treatment. And maybe right after the "bone crunch" followup with the other 30 minute massage to relax the muscles again. Of course, that would require seeing the patient twice which might be time consuming, but if ultimate patient satisfaction is the goal...it might be worth it.

Would something like that work?

I'm interested in work with chiropractors and that's the reason I joined this forum

Jim

Hi Everyone! So I was thinking today about a couple things. I would like your opinions on.

1. The proposed "Advanced Certification Exam" by the NCBTMB? Many of us in a chiropractic setting have special skills and work in a professional health care setting. What do you think about it and will you take it?

2. Other group discussions I belong to many have a very unfavorable view of working as a massage professional in a chiropractic clinic. I know there some people with poor experiences out there, but there can be some great partnerships formed. Massage professionals can be a great asset to a practice. So have any of you worked in more than one clinic? How long have your worked in the clinic you work in now?

Respond to one, both, or none. Just curious.

Ivy
I-O-W-A
Advanced Massage Techniques

just wanted to let everyone know i appreciate the comments and i am working with someone who teaches insurance billing so I am excited to see what they have to say. the one thing she did tell me is that billing is all about the wording and tenacity.

aloha everyone ~
i have worked with two well-trained, ethical and soft-tissue savvy DC's for six years with great success. both chiropractors are focused on rehabilitating patients (although there are some, of course, with structural abnormalities, e.g., ideopathic scoliosis, where we do our best). in addition to top chiropractic colleges they are also certified practitioners of active release technique, giving them great insight into soft tissue.
i show up with linens and oil, and he refers clients. i spend no time marketing or administrating. he employs a top administrator. all i have to do is focus on treating the patient, complementing his practice. i practice orthopedic massage, using myofascial release, neuromuscular therapy (including spray-n-stretch), cranio-sacral and numerous stretching techniques along with moist heat therapy and cryotherapy (ice). we also offer pilates and yoga private and couples classes for rehabilitation.

Funny you should bring up Active Release Technique. I had a client in the other day who was undergoing ART right now. Has anyone here taken a course in ART?
Ivy Hultquist
Advanced Massage Techniques

I was wondering if anyone knows how many massage therapists are working in chiropractic settings. Also, are massage therapists being cross trained as chiropractic assistants? Chiro assistant seems to be growing and I wondered if there was much or any crossover.

Hi Kellie! When writing a CE course I researched this topic a little. I was not able to find out how many MT's are working as CA's or CT's. However there are a couple of issues I did find as far as MT's crossing over as CA's.

A few states have started to license or register CA's and working within a MT's scope of practice becomes an issue for some practitioners.

The pay scale for a CA is considerably lower than a MT, but an experienced MT should be able to negotiate a higher salary if they are going to work as a CA and provide massage therapy.

In many offices CA's do a lot of clerical work, including billing and scheduling, along with other duties such as physiotherapy or x-ray development. Many MT's take jobs as a CA and find they are doing more clerical work and less massage therapy than expected.

I believe the CA field will grow and hopefully this will benefit MT's who are looking for jobs in a chiropractic setting.

Ivy Hultquist
Advanced Massage Techniques

That's great information, Ivy. Thanks! It seems to make sense that there could be more opportunity for CA/MT positions...chiropractors are struggling too and if they can get one person in a position with dual skills, that saves them money. We did a little research last week and found that 8 of the US chiro schools are now offering CA programs or courses. Those offering massage programs have been increasing as well.

just so you know, i just started discussion in the trigger point discussion forum on the topic of using "spray & stretch". please feel free to join in.

Hi everyone,
I just joined this group. I've been working in a chiropractic office for over a year and it has been eye opening. The chiropractor I work with is very big on educating everyone (clients, coworkers, skeptics) about the benefits of chiropractic, which are far different than what I thought they were. Chiropractic is not just about "cracking the bones", in the case of my chiropractor it's not even remotely about that at all. It's about keeping the nervous system clear and if you can do that so many ailments can be cleared up such as depression, insomnia, irritability, etc. I love working with Dr. Trapper.

Hi, o opened my own practice in a Chiropractor's office June 1. I am an independent contractor , which is what both myself and the doc wanted. He is an ART provider and does Graston Technique also. He uses ART more than manual adjusting so he doesn't need me to "warm up" muscles for him. We refer back and forth. Sometimes i work on his patients prior to his treatment and other times after or on days when they don't see him. I love it. We compliment each other very nicely. Most of what i do is neuromuscular treatment. I use moist heat, aromatherapy and my hands. I hae brought some clients into the office through my friends and contacts, though the majority of my clients have come from the doc. We have releases signed if clients are seeing both of us so that we can discuss the case. He's a great teacher. Its working out very well.

Welcome Jacqueline and Deirdre! Jacqueline, I think you brought up a great point with the release forms for discussing clients since you are not technically an employee. I am interested if any other IC's on here have similar measures in their practice. With HIPPA and patient/client confidentiality it makes a lot of sense.
Deirdre- The nervous system is amazing! Nerves leaving the spine affect not only our muscles, but all other organs and body systems. Chiropractic is great a great help for physical pain and more.

Another question to the group. Has anyone had any specific training for working in as a massage therapist in a chiropractic office?

Ivy Hultquist
Advanced Massage Techniques

Hi everybody. I am not working in a chiropractic setting but I would like to do it as an independent contractor. But it has been very hard for me to find a chiropractor that wants to work this way with a massage therapist in my area (south Florida). All of them want to pay a salary to the massage therapists, between $12 and $18 the hour, which I personally consider not good. What can I do in order to find a chiropractor that wants to work with me as an independent contractor, so we can work together treating the same patients and billing insurance companies? What would make a chiropractor interested to work this way with a massage therapist? Any suggestions, ideas and recommendations would be highly appreciated! thank you!

There are a couple of options for you. You could send out a letter to introduce yourself to chiropractors in the are and mention any special training you have acquired. Express you interest working as an independent contractor or working on a referral basis with their patients (in the meantime). A referral arrangement can help you maintain your independence and work with chiropractic patients until you find a permanent spot in a clinic.
Just an idea.
Ivy Hultquist
Advanced Massage Techniques

Angela, see if there are any chirporactors in your area that are ART certified. ART is Active Release Technique. This type of doc doesn't necessarily need you to "warm up" muscles prior to his adjustments as ART does that to some degree. This is the situation i am in. The chiropractor that runs the office wanted to add a massage and neuromuscular therapist to provide another facet of healthcare to his patients. Also, approach a chiropractor from the perspective that you will be bringing in clients to the office and that you and the doc can refer back and forth. So in my situation i run my business. Sometimes i see the doc's patients prior to his treatment and sometimes i see them after. Sometimes clients come just to see me for neuromuscular treatment. Having NMT certification is really important for your marketing as well as treatment of clients who come to a doctor's office. Does this help?

I actually would also go chiropractor shopping as if you were looking for one for yourself. Go in and see if they have a comp session or will meet with you to ask questions. When you find one that seems like they have good values go and see them for a few sessions. Send them a few clients first. Then start talking about just what you can do for their business and how you will help their clients and improve healing and client satisfaction etc.

You could also create an info packet with things like research, your bio with a philosophy on healing, your business plan, your plan for getting new clients and don't just rely on them for building your business. Tell them how you are going to build their business. Make it about them!

Julie

Great insight Julie.

Thank you so much Julie, Jacqueline and Ivy! I definitely would take in consideration all these ideas, all are great! I really want to work as an independent contractor, I am going to get two more certifications (Erik Dalton's technique and other) and then start following all of this. I will keep you posted! thank you again! :)

Oh! I think I found a great chiropractor, she is specialized also in functional medicine, clinical nutrition and endocrinology practitioner. I would love to work with someone like her but the problem is that she already have LMT's on her staff. What can I do if the chiropractor I am interested to work with has already LMT's on his/her staff? Because it seems the most of them already have LMT's! :(

Angela are you working as a massage therapist now?
Getting additional training puts you on the right track. I always look for ways to set myself apart from the rest of the therapists.
If you have a good resume bring it to the offices that our are interested in. Eventually someone will be looking to fill an empty position. Making personal contact by going to the office and meeting the front desk person is really useful. Do you have a chiropractor? Start treatment yourself if not for a specific issue for an overall evaluation. Follow what Julie said below.

Angela--see if she'd be willing to put you on an on-call/substitute list, such as if any of the MTs she works with need an emergency day off, want to take a vacation, get injured, etc. Perhaps you can peripherally integrate yourself into the office by doing trades with some of the MTs she has on staff; the more you raise your profile in that office, the more likely they'll be to turn to you if they need someone.

Alternatively, ask the chiro! She may be looking for more/different people, she may be open to the idea of adding on someone new, etc. There's information online about how to write a cover letter when cold-calling for a job. Basically, find out about her work and come up with a reason that she needs you. What makes you unique? What do you bring to the table, so to speak?

Thank you again for your great ideas! Thanks Erica and Jacqueline! :)

Hi everyone! I am in the process of starting a business as an independent contractor MT for chiro offices and rehab centers. Can anyone give me some feedback with what an independent contractor should include in their contract with these facilities. I am worried that I may not think of something and be caught off guard and it hurt the start of my business.

Carla--MT Radio is doing a free webcast on Feb 25 about better business arrangements for massage therapists. You can go here to sign up and to leave some questions. It sounds like a perfect fit for what you're looking for!

Erica--thanks for the info. I will check out about signing up for the webcast.

Dear colleagues,

I am happy to invite you to join my group:” Medical and Sports Massage” including FREE Medical and Sports massage lessons. Not alot of practitioners in the US are familiar with Russian Medical and Sports massage as it was proposed by a Russian physician professor of medicine Anatoly Sherback . I'm happy to offer you information about this methodology as well as some additional information about me. I hope that our friendship will be pleasant and mutual beneficial. I believe in sharing knowledge. In such a case you will be able to learn from me as well as I can learn from you . If after reading information about medical and sports massage, or viewing lessons you will have any question I'm encouraging you to make comments or initiate discussion topic . In such a case my replies will be available for many to read, as well as your replies. Looking forward for great relationship.

Best wishes.
Boris

I began my massage therapy career working for a chiropractor. It was an educational experience. I loved being a part of the healing community.

looking forward to networking with everyone

Billie

I am looking for an article for my website about working in a chiropractic office  clinic, positives and negatives, pay scale, etc.  and why massage therapists choose to do this. If anyone is interested in writing about this please let me know. Just need a short article-not printed somewhere else. Thanks!

www.massage-education.com

i've been earning commissions for the past 11 years in a chiropractor's office. last week he advised me that he now wants me to pay $3500 rent per month for 3.5 days per week, or $230 per day (8 hour day with lunch break). this seems excessive. 

i think i need some comparables and was wondering what others are paying to rent a room in a chiropractor's office with a receptionist. please help. thanks.